Relationship between different cervical curvature and spinal cord posterior movement after laminectomy with lateral mass screw fixation and its influence on the operative effect / 中国综合临床

Objective@#To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.@*Methods@#From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.@*Results@#The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05).@*Conclusion@#The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.

Comparison of cervical motion range and curvature after C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty / 中国组织工程研究

BACKGROUND: Axial symptoms often occur in patients after posterior cervical single-door vertebroplasty. Some studies have proposed a modified surgical method to remove C3 lamina and retain cervical semisacinous muscle on C2 spinous to reduce the occurrence of axial symptoms after surgery. OBJECTIVE: To compare the clinical effects, cervical motion range and curvature of C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty. METHODS: Totally 43 patients with cervical spondylosis were selected from the General Hospital of Southern Theater Command of PLA from June 2012 to June 2017, including 25 males and 18 females. Among them, 27 patients underwent C3-6 or C3-7 single-door mini-titanium fixation vertebroplasty as fixation group and 16 patients underwent C4-6 or C4-7 single-door mini-titanium fixation vertebroplasty through posterior approach after C3 laminectomy as resection group. Preoperatively, 6 months postoperatively and at final follow-up, JOA score, cervical motion range, and C2-7 Cobb angle were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA. RESULTS AND CONCLUSION: (1) All 43 patients successfully underwent the operation without vascular or spinal cord injury. (2) JOA score was higher in the two groups at postoperative 6 months and final follow-up than that preoperatively (P 0.05). (3) Motion range in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). Motion range was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (4) C2-1 Cobb angle in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). C2-7 Cobb angle was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (5) There was no hypersensitivity, rejection or immune response in the two groups. (6) Results indicate that C3 laminectomy and mini-titanium plate fixation have the same effect on improving neurological function, but the removal of C3 lamina can more effectively prevent the reduction of postoperative cervical motion range and curvature.

Relationship between Cervical Curvature and Spinal Drift Distance after Laminectomy with Screw Fixation and Its Effect on Clinical Outcome / 中国康复理论与实践

Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C5 palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C5 palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C5 palsy.

Effect of Laminoplasty with Reconstructing of Cervical Extensor Attachment on Cervical Spondylotic Myelopathy Involving C2 Segment / 中国康复理论与实践

Objective:To observe the efficacy of laminoplasty with reconstructing of cervical extensor attachment on cervical spondylotic myelopathy (CSM) involving C2 segment. Methods:From March, 2014 to January, 2017, 46 cases with CSM involving C2 accepted surgery in our hospital. They were divided into two groups according to the surgical methods. Control group (n = 21) accepted traditional laminoplasty, while observation group (n = 25) accepted laminoplasty with extensor muscle attachment point reconstruction. They were assessed with Japanese Orthopaedic Association (JOA) spinal scores, cervical range of motion (ROM), cervical curvature, areas of posterior cervical muscles and axial symptoms. Results:There was no significant difference at operative time and intraoperative blood loss (t < 0.863, P > 0.05) between groups. After surgery, the JOA score increased in both groups (F > 24.961, P < 0.001), but there was no significant difference between two groups (t < 0.282, P > 0.05). ROM varied little in both groups (F < 0.931, P > 0.05). The cervical neutral position curvature decreased in the control group (F = 8.241, P < 0.01), but not in the observation group (F = 2.705, P > 0.05). The areas of posterior muscle decreased in control group (t = 2.678, P < 0.05), but not in the observation group (t = 0.854, P > 0.05). The incidence of axial symptoms was less in the observation group than in the control group (Z = -2.192, P < 0.05). Conclusion:Laminoplasty could relieve the spinal compression at C2 segment and promote the recovery of neurological function, and it can do better in cervical curvature and posterior cervical muscle atrophy as combination with reconstruction of extensor muscle attachment, to reduce the axial symptoms.

The prevention and cure of postoperative neck axial symptoms after open-door laminoplasty for cervical spondylotic myelopathy / 中华物理医学与康复杂志

Objective To evaluate the effectiveness of rehabilitative treatment after extended open-doorlaminoplasty of the cervical spine for cervical spondylotic myelopathy.Methods Sixty patients(mean age 61.7 ±12 years)who had undergone extended open-door laminoplasty of the cervical spine for cervical spondylotic myelopa-thy were studied for an average of 40.7 months.They are divided into a rehabilitation group and a control group with 30 patients in each.The patients in the rehabilitation group received systematic rehabilitation therapy pre-and post-operation.In both groups,the neurological recovery rate,the cross-sectional areas of the cervical posterior muscles,and the incidence of axial symptoms and post-operative complications were recorded and compared. Results The wounds of patients in the rehabilitation treatment group healed with no complicating infections,but the wounds of three patients in the control group became infected.There was no statistically significant difference in neurological recovery between the two groups.In the rehabilitation treatment group,the rate of atrophy and the cross-sectional areas of the cervical posterior muscles were significantly lower than in the control group.At the same time,the rate of neck axial symptoms was 23% in the rehabilitation group but 60%in the control group.a difference which was statistically significant. Conclusions Although rehabilitation treatment pre-and post-operation may not speed up neurological recovery,it may prevent postoperative atrophy of the cervical extensors and lower the incidence of neck axial symptoms.

Validity of FASTIN anchor in cervical laminoplasty / 中国矫形外科杂志

[Objective]To evaluate the efficacy and short-term results of FASTIN anchor in cervical expansive open-door laminoplasty(ELAP).[Method]From February 2005 to February 2006,a total of 89 cases of cervical spondylotic myelopathy(CSM) were assessed in this study.Forty patients undergoing expansive open-door laminoplasty(ELAP) by FASTIN anchor were classified as study group.Fouty-nine patients undergoing conventional ELAP served as controls.The clinical results and radiological examinations of both groups were evaluated at 24 months after surgery.[Result]There were no significant differences in operation time,bleeding quantity and recovery rate of Japanese Orthopaedic Association(JOA) scores.The incidences of axial symptoms and C5 palsy in the study group were significantly lower than those in the control group(P

Clinical application of the modified open-door laminoplasty perserving semispinalis cervicis insert into axis / 中国矫形外科杂志

[Objective]To verify whether or not the modified open-door laminoplasy preserving semispinalis cervicis insert into axis is effective in preventing postoperative axial symptom and maintaining postoperative cervical sagittal alignment.[Method]Since March 2002 to December 2003,forty-eight patients underwent modified open-door laminoplasy preserving semispinalis cervicis insert into Axis,among them,thirty-two patients who were followed up for more than 2 years were included in this study.Preoperative and postoperative JOA score,degree of axial symptom,ranges of neck motion,cervical curvature index were recorded and compared.[Result]Preoperative and postoperative JOA score was(9.04?2.9)and(12.5?3.1)respectively,with recovery rate as(44.9?26.9).There was significant difference between preoperative evident axil symptom rate(46.8%)and postoperative evident axil symptom rate(18.7%),while no significant difference between preoperative and postoperative ranges of neck motion,cervical curvature index was seen.[Conclusion]Modified open-door laminoplasy is less invasive to the posterior extensor mechanism especially the semispinalis cervicis than conventional open-door laminoplasy.This new procedure is effective in preventing postoperative morbidities often seen after conventional laminoplasy with adequate decompression of the spinal cord.

Influence of Individual Symptomatology on the Surgical Results of Parkinson's Disease

Changes in the individual symptomatology were analyzed on twenty-nine patients with Parkinson's disease who underwent thirty-five stereotaxic thalamotomies to evaluate the influence of each symptom on the surgical results. The thalamotomy could obviously improve and prevent progression of tremor and rigidity but not bradykinesia and axial symptoms. Long-term follow-up wtudy with statistical analysis suggested that progressive worsening after surgery was due not to recurrence of tremor and rigidity but aggravation of bradykinesia and axial symptoms in the natural course of the disease. We believe that timely surgical treatment should be encouraged in patients presenting symptoms of tremor and rigidity.